Fast Discharge After Acute Myocardial Infarction Discharge MI
Fast Discharge After Acute Myocardial Infarction Discharge MI - A Randomized Multicenter Non Inferiority Trial
Medical University Innsbruck
2,070 participants
Dec 1, 2024
INTERVENTIONAL
Conditions
Summary
To evaluate the hypothesis that a fast discharge strategy (discharge at 24 \[± 12\] hours) following invasive management for acute myocardial infarction is non-inferior to standard of care (\>36 hours) with respect to the risk of major adverse cardiovascular events (MACE) during follow-up.
Eligibility
Inclusion Criteria4
- Uncomplicated acute myocardial infarction (NSTEMI and STEMI) diagnosed according to the 2023 acute coronary syndrome guidelines of the ESC
- Age ≥ 18 years at time of consent
- Invasive management strategy and in case of PCI successful intervention of the culprit lesion defined by post-interventional TIMI 3 flow
- Ability to understand and willingness to sign and date written informed consent
Exclusion Criteria10
- Myocardial infarction complicated by cardiac arrest (out-of-hospital cardiac arrest/in-hospital cardiac arrest)
- PCI-related complications (coronary perforation, side branch closure, inability to deliver stent/balloon, aortic dissection, allergic reaction grade ≥2, stroke/thromboembolism, access site complications including pseudoaneurysm, arteriovenous fistula, retroperitoneal hemorrhage and arterial dissection/occlusion or emboli)
- Malignant arrhythmias including sustained ventricular arrhythmias and persistent bradycardia (\< 50 beats per minute due to sinus node or atrioventricular conduction system abnormalities, second- /third-degree atrioventricular block) after PCI
- Ongoing hemodynamic instability (systolic blood pressure \<90 mmHg, elevated lactate concentrations, need for inotropes or vasopressors)
- Ongoing respiratory instability defined by Killip class \>I (rales, pulmonary edema)
- Ongoing quantitative disorders of consciousness (somnolence, sopor, coma)
- Acute kidney injury defined by Kidney Disease Improving Global Outcomes (KDIGO) stages 2 and 3
- Pregnancy
- Untreated critical non-culprit lesions requiring revascularization during index hospitalization not allowing fast discharge
- Immobility/limited mobility or social circumstances that prevent fast discharge assessed by an interprofessional care team
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Interventions
Patients undergoing invasive management after myocardial infarction will be discharged after 24 (+/- 12) hours.
Locations(8)
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NCT06744322